| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Professional | $131.38 | $131.38 | $149.30 | |
Medica
| Professional | $500.00 | $500.00 | $500.00 | |
Molina
| Professional | $58.40 | $58.40 | $58.40 | |
Quartz
| Facility | $201.18 | $201.18 | $201.18 | |
Quartz
| Professional | $174.53 | $500.00 | $500.00 |